This is a proposal to perform a controlled clinical trial of a computer-based quality assurance mechanism. To implement this mechanism the responsible physicians must state their standards of care in terms of simple condition/response protocols. Under protocol control, the computer then prospectively examines each patient record before his next visit and calls attention to conditions that need clinical attention. The present standards of care applied to the medicine clinics at Wishard Memorial Hospital will be embodied in a large set (we estimate 2,000 -2,500) of formal protocols which collectively provide reminders about management of most common clinical events. The effect of this system will be studied on physician subjects whose patients have been randomized into either a study or a control group. The physicians will receive protocol generated reminders when caring for patients from the former group but not when caring for patients in the latter group. The effect of this system on care process will be measured by the differences in rate of compliance of physicians when caring for study patients as compared to compliance rate when caring for control patients. The effect on outcomes will be measured by the difference in death rate, hospital days, emergency room visits, total health care charges and a weighted measure of objective parameters such as the hemoglobin, blood pressure, etc. We wish to determine whether this automatic quality assurance mechanism will improve physician's compliance to process standards and whether improved compliance will lead to improved patient outcome.